Vulvar abscess secondary to a congenital recto-vestibular fistula in a 2-month-old female: a case report

Perineal canal is a rare anorectal malformation with a normal anus, most commonly seen in East Asian countries. Presentation of this disorder in Western countries often do not involve an inflammatory process and are incidentally found later in childhood. A healthy, full term female infant presented to an outside hospital at 8 weeks old due to purulent, bloody discharge noted in her diaper. On exam she was noted to be febrile and found to have labial swelling. She was diagnosed with a left labial abscess and a urinary tract infection. Urology was consulted to evaluate the patient due to the urinary tract infection. Urology noted on physical exam that the patient produced stool from her anus and an orifice near the 4 o'clock position of the vaginal introitus simultaneously. Pediatric Surgery was consulted to evaluate the patient. The child completed an antibiotic course and was scheduled to follow up in surgery clinic. The child returned to the hospital prior to clinic follow up due to recurrent fevers, increased drainage from the fistula, and worsening irritation of her labia. An exam under anesthesia was performed of the rectum and the rectovestibular fistula was identified. She initially underwent excision of the rectovestibular fistula without diverting ostomy, but experienced wound breakdown requiring diversion. Her fistula repair has fully healed, and her ostomy is now reversed. The presence of a labial abscess in a female infant should prompt a thorough physical exam to assess for a rectovestibular fistula.